help needed w/ client

[Poon Tang]

this gentleman is in his 60's. He states pain in upper back area. His back in the thoracic area is bowed out, sorta like pics of mild kyphosis (a medical diagnosis i'm not qualified to make). His whole upper back is very hard and dense..i cant palpitate anything. But his upper traps are flaccid.
I dont how to massage him. How do i address his upper back? I cannot feel his scaps or spine, let alone any muscle tissue.
Second question...i have moist heat pacs. His skin however pinks up quickly. Is it safe to use the heat pacs on someone like this?
I'd be so grateful for any suggestions, thanks.

 

[Sammzie]

His upper back muscles are WAY overstretched. I would work on chest and anterior shoulders more, especially stretching the pecs. You will find those quite hypertonic - that is what is pulling so hard on his back. His SCM & scalenes will probably be hypertonic, too. Start gently - it will hurt.

 

[Pompal 09.]

His upper back muscles are WAY overstretched. I would work on chest and anterior shoulders more, especially stretching the pecs. You will find those quite hypertonic - that is what is pulling so hard on his back. His SCM & scalenes will probably be hypertonic, too. Start gently - it will hurt.

Yep - what she said. :-D

While the pain is felt in the back you need to be careful not to fall into that trap - you can actually worsen the condition.

Flip him over and work the pecs and other muscles in in the front of the chest, rib cage, neck and shoulders.

Blessings, Angela

 

[Marie S]

he is coming back to see me. I didnt do any aggresive work, since it was his first massage, and he just wanted to relax mainly. He is a carpenter, his pecs are huge, but his upper traps across the tops of his shoulders are so flaccid. I did a little muscle stripping into the pecs with his arm raised, but they were so huge and tight i dont think it did much.

Any suggestions on how to work his pecs effectively? Should i start him supine and work the pecs first? I could warm them with moist heat pacs, do his legs for a bit, and then work on his pecs? Then turn him over and i dont know what with his back, everything was so taut...

thanks so much,

 

[kait]

That sounds like a good plan. I'd do some lighter strokes, then gradually work a bit deeper, then stretch them really, really good. Stretching them can also be done, sometimes more effectively, when he's prone - just lift that shoulder and hold it. I sometimes loop my arm through the client's arm so I am holding his more with the inside of my elbow, straightening my legs as I lift. Then my legs are doing the work and I can hold the stretch much longer.

 

[Pompal 09.]

You can also do some resisted stretches to loosen the pecs without deep tissue work - I call it hold, release, stretch but I know there are fancier terms for it.

When the client is positioned face up you can stretch the pecs by bring the arm up and back - I usually do it with a straight arm. Have him think about bringing his hand over to his opposite hip which will activate the pecs muscles. Resist the movement and hold for about a 10 count. Tell the client to full relax - this can be difficult for some to learn....they want to totally release. Wait for a moment and then stretch a bit further. Monitor the client's pain levels, stiffness and what they are feeling. If there is joint pain stop. Usually they'll just say it feels tight - you only want to stretch to that point of stiffness and then have them resist your pressure again. The arm never actually moves until you stretch it again.

I use this a lot with chronically tight pecs, hamstrings and psoas which can all be tender to work directly on when the muscles are hypertonic.

Angela

 

[Begum]

As mentioned above, some other stretching may be called PNF stretching, in case you want to do a google search on more info.

Here is an article that may be of help for an pectoral stretch.

Pectoral Stretch

This stretch can be easily performed without a partner by using a doorway or other stationary object for resistance. The stretcher begins by raising one arm to a 90 degree angle at the elbow, with the upper arm parallel to the ground and forearm perpendicular to the ground. Placing the forearm and open palm against the doorway, the stretcher will turn the body away from the arm until a comfortable stretch is felt through the chest and into the shoulder. Hold this stretch for 15 seconds. Then, isometrically contract the pectoral muscle, attempting to adduct the arm. Hold this contraction for six seconds. Relax the pectoral muscle and deepen the chest stretch by turning the body away from the arm for another count of 15 seconds.

And here's a picture: http://www.healthline.com/hlbook/art-pectoral-stretch

Just a little link while we're on the subject. I found this book while searching. It looks like it might be good. Facilitated Stretching-3rd Edition http://www.humankinetics.com/products/showproduct.cfm?isbn=0736062483

 

[Bilge Rat]

I was just going to suggest PNF - that should work great with him.

I agree with the advice you have gotten so far. Also encourage him to do some stretching on his own.

 

[Wisen Smart]

Yep - that's the term that was elluding my tired brain.

If you've ever seen the Micheal Critz CD he does a really good job showing how to do this.

I often will show clients how to do the stretch in the doorway if this is an area impacted.

Angela